Help the 500,000 immunosuppressed people in the shielding group by ensuring they’ve had a full course of Pfizer or Moderna, to give them the same chance of being protected as everyone else.

This group includes people having cancer treatment, having organ transplants, or taking medicine for diseases like rheumatoid arthritis or Crohn’s that weakens their immune system.

The shielding programme for the clinically extremely vulnerable has officially finished, but many of the 500,000 people in the immunosuppressed group are trapped living in a state of extreme cautiousness, while some of them have no choice but to increase their exposure in their day to day lives. With very few covid related restrictions now in place in the UK alongside high case rates, the immunosuppressed are more exposed than ever before. 

The Facts:

1. It is now accepted that immunosuppressed people's immune systems respond better to Pfizer or Moderna (mRNA type) vaccination than AstraZeneca (AZ). 

2. It is now accepted that immunosuppressed people on average need three doses of covid vaccine to give the same response as two doses for a person with a normal immune system. As a result, in September, the JCVI recommended a third primary dose for the immunosuppressed group followed by a booster six months later.

The Problem:

1. Many of the 500,000 immunosuppressed members of the shielding group, will have had AZ for their first two doses. On average this would have been less effective for them versus the general population or their counterparts who had Pfizer. The advice to exclusively give Pfizer to the under 40's came after the shielding group was vaccinated, so it is likely a large number of this group had AstraZeneca.

2. As the shielding group got vaccinated very early, by the time it was realised that the immunosuppressed needed an extra third primary vaccine (in September following the OCTAVE study), around 6 months had already elapsed since second doses. For many, this gap was too long to prime the immune system. France took a more proactive stance on the immunosuppressed early on during the vaccine roll out and routinely issued three Pfizer doses to this group with doses staggered in quick succession.

The Outcome:

It follows that many in the immunosuppressed group in the UK would have had lower levels of antibodies following their second dose versus the general population, particularly if they had AZ. After 6 months of waning protection many would have low or undetectable antibodies by the time of their third primary dose. Fortunately, mRNA vaccines are being recommended for the third primary dose for the immunosuppressed so a better response would be likely. For some this wouldn't provide full protection in the same way a "booster" top up dose would for the general population. An immunosuppressed person with a weak or undetectable level of antibodies as a starting position, would be less likely to generate strong antibody levels as a result of a single extra vaccine dose.

So, while the general population that are eligible for a booster get topped up from a reasonable starting position back to a full complement, many of those in the immunosuppressed group are starting from a nil or very low base point and need a further dose.

Previously it was thought that the cellular immunity granted by vaccination (memory B cell and memory T cell) would also provide some protection alongside antibodies. However, we know now that it’s not enough. If it was, then we wouldn’t need a booster programme. Without a strong level of antibodies, you are more likely to get infected and the virus gets a head start.

The Solution:

The OCTAVE DUO study is ongoing which is looking at this issue. However, we shouldn’t wait until after winter for the results when protection is needed now for the vulnerable over the winter peak. 

The booster programme takes this sensible approach and will give the rest of the at-risk population including over 50s and other vulnerable groups a top up even though some may not need it. It may soon be expanded to even more people. The immunosuppressed are somehow back to a state where they still only receive the same number of vaccination doses as everyone else, despite the JCVI position that they need more. A booster in Spring 2022 is no use to them when many need another dose now.

My Appeal:

The story above reflects my personal situation. I had several spike protein antibody tests over the course of my vaccinations. I had weak antibody levels after my second AZ dose in April and then undetectable levels of antibodies 12 weeks later in July. They had waned away completely. My recent Pfizer third primary dose in September brought this up from zero to moderate levels which is the best result yet. However, I need another dose to get strong antibody levels and the same protection as everybody else. 

I have children at school and nursery and a wife who works in the NHS who sees covid positive or covid suspected patients in the course of her job. I can keep myself as safe as possible, but the virus will inevitably come to our house at some point through my family. I am just one data point but given what we know, I am likely to be one of many immunosuppressed people in the same situation. Most immunosuppressed people haven't had the benefit of testing, so don’t know they could have an urgent problem.

I have raised this with my hospital specialist and provided my antibody test results but there is nothing he can do, even though I can evidence clinical need for another vaccine.

Join me in this petition to ensure the immunosuppressed have had a full course of Pfizer or Moderna to give them the same protection as everybody else over the winter months.

Thank you